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The American Journal of Accountable Care September 2018
Improving Population Health Through Multistakeholder Partnerships
Nicole Sweeney, BA; Sarika Aggarwal, MD, MHCM; Peter Aran, MD; Deb Dahl, MBA; Joseph Manganelli, PharmD, MPA; Steven Peskin, MD, MBA; Emily Allinder Scott, MHA; David Parker, PhD; Joseph Conoshenti, RPh, MBA; and Anupam B. Jena, MD, PhD
A Model for Delivering Population Health Across the Care Continuum
Sanjula Jain, PhD; Adam S. Wilk, PhD; Kenneth E. Thorpe, PhD; and S. Patrick Hammond, MHA
Team Functioning and Clinical Quality, Patient Satisfaction, and Patient Portal Implementation Among Patient-Centered Medical Homes
Deirdre A. Shires, PhD; Amir Alishahi Tabriz, PhD, MD, MPH; Carrie A. Miller, MPH; and Jennifer Elston Lafata, PhD
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“Lean” Improvement in the Quality of Patient Care in the Hospital Admissions Process
Patricia Bonachela Solás, BSc; José Bernabéu-Wittel, MD; M. Nieves Romero Rodríguez, MD; Antonio Castro Torres, MD; and Diego Núñez García, MD
Trends in Healthcare Payments: Focus on Consumer Experience as the New Normal
Chris Seib, BS
Effectiveness of Enhanced Primary Care on Preventive Health Services
Sarah L. Goff, MD; Lorna Murphy, MA, MPH; Alexander Knee, MS; Haley Guhn-Knight, BS; Audrey Guhn, MD; and Peter K. Lindenauer, MD, MSc

“Lean” Improvement in the Quality of Patient Care in the Hospital Admissions Process

Patricia Bonachela Solás, BSc; José Bernabéu-Wittel, MD; M. Nieves Romero Rodríguez, MD; Antonio Castro Torres, MD; and Diego Núñez García, MD
The objective of this work is to improve the quality of patient care in the admission office service of the University Hospital Virgen del Rocío (HUVR) by standardizing and systematizing its procedures using Lean methodology. The results have allowed HUVR to achieve continuous improvement in the process, eliminating the elements that do not add value.

Objectives: Among the most important challenges that a healthcare system faces are money flow and the quality of the care provided to patients. Lean methodology (LM), as a management method in healthcare, has helped to improve the delivery of care and service to patients. In our hospital, the admission services were decentralized, heterogeneous, and perceived by patients and clinical staff as inadequate, which had an impact on patient care. Our objective was to enhance the quality of patient care by improving the admissions office service.

Study Design: The University Hospital Virgen del Rocío is a tertiary hospital with a reference population of about 554,097. Four admissions offices work independently to manage hospital/inpatient admissions, emergencies, surgery, and outpatient appointments.

Methods: To unify the admissions processes and systematize and standardize these procedures, LM was applied.

Results: Communication problems with patients and among staff groups involved in patient care were identified, and solutions were found and implemented. Patient pathways have been improved, with a resultant positive effect on patient perceptions of quality.

Conclusions: With the utilization of LM, the admissions services have put ongoing rapid improvements of the admissions process into place, eliminating elements that do not add value. Among the limitations found during this project were that some staff members had limited experience in LM and the time assigned to follow-up tasks was scarce. Thanks to the use of LM, it has been possible to achieve standardization and homogenization of the admission services’ processes, improving the quality of assistance provided to patients.

Am J Accountable Care. 2018;9(3):e1-e7
In the last several decades, the concept of improved management has been introduced among healthcare providers, specifically to optimize the use of available resources and improve patient care. Although much progress has been made, it is still uncertain if this progress has had the expected impact on care provided to patients (ie, if the achievements or improvements should have been more significant).1

Currently, the public healthcare system in our region of Spain, the Andalusian Health Service, faces important challenges, including among others a continuous increase in demand, an aging population, and a shortage of resources. New management strategies are therefore required to improve efficiency, optimize resources, and improve quality of care.2

There is increased interest in the creation of effective healthcare teams trained in patient safety methods and involving patients.3 Lean methodology (LM) has gained popularity in the area of healthcare management as a way to improve patient care and efficiency by eliminating elements that do not add value.4

The Lean model is based on the Toyota Production System (TPS). At Toyota, the Japanese automobile manufacturer, car production was developed in accordance with the Lean manufacturing system instead of using the traditional method based on mass production. Taiichi Ohno, the engineer who pioneered TPS, characterized the key aims of the Lean system through 2 main principles: continuous improvements, such as improving efficiency by eliminating or reducing waste, and respect toward employees.5 The main purposes of TPS were to reduce the cost of the process and increase productivity, eliminating activities that do not provide any additional value to the product. TPS as an innovation in manufacturing management appeared as a response to both the lack of available resources and the financial pressures in Japan’s post–World War II economy in the 1950s. These factors, plus the fact that Toyota had overproduced vehicles that were sitting unsold, placed Toyota in a precarious financial situation.

Toyota’s initial approach to improve efficiency was based on the introduction of teams that were charged with finding the best ways to operate various aspects of production. These teams, the predecessors of quality circles and Kazen teams (continuous improvement), focused on working in small sets of people to develop a new system. This new system consisted of coordinating the flow of materials or parts so that each of them could be manufactured only if they were necessary in the next step of the chain. That system was called the pull system, or “just in time.” The key tool developed by Ohno was the Kanban (information card), which represented the link of the whole new system of production.6

Gradually, the concepts of TPS expanded beyond Toyota and became standard for production and management in the manufacturing industry. TPS combined the benefits of small sets of production, manufacturing according to customers’ orders, continuous upgrading of quality in both product and procedures, and economies of scale in manufacturing and sales.

TPS allows for continuous improvement in product quality and a dynamic production, management, and organization system. When the Lean system began to revolutionize auto manufacturing, interest worldwide intensified in the philosophy and concept of Lean manufacturing, due to its superiority in terms of quality measures, flexibility, and rapid responses.7 Today, extensive literature documents the success of the implementation of Lean techniques.8-10

After Lean philosophy succeeded in helping the manufacturing industry, it expanded into the service sector, including healthcare. Although substantial differences undeniably existed between the manufacturing industry and the provision of healthcare, the creators of Lean supported2 its use in healthcare systems, noting that the first step of implementation would be to place the patient first and to always consider patient comfort and care time as the keys to the system’s success.11

Appreciation of the Lean philosophy’s implementation in healthcare is growing substantially.12-22 Lean healthcare, as it is known, benefits healthcare in 4 major areas: improvements in safety and in quality, better clinical services, better efficiency, and impulse for continuous improvement. Along with any of those comes another significant benefit: elevating the morale of the staff.

Two additional advantages that come from implementing LM in healthcare are, first, that it helps to identify problems in the system and turn them into opportunities for improvement, and second, that it helps to demonstrate the causes of those systematic problems.2

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